Pediatric Diseases and Conditions

Inguinal and Umbilical Hernias in Children

What are hernias in children?

A hernia is when a part of the intestine pushes through a weak spot in the belly (abdominal) muscles. The hernia creates a soft lump or bulge under the skin.

In children, a hernia often happens in 1 of these 2 places:

The groin area. This is called an inguinal hernia.

Around the belly button. This is called an umbilical hernia.

What causes a hernia in a child?

A baby can develop a hernia in the first few months of life. This happens because of a weakness in the belly muscles. Inguinal and umbilical hernias happen for slightly different reasons.

During pregnancy, all babies have an area called the inguinal canal. This goes from the abdomen to the genitals. In boys, this canal lets the testicles move from the belly to the scrotum, the sac that holds the testicles. Normally, a baby’s inguinal canal closes shortly before or after birth. But in some cases the canal doesn’t fully close. Then a loop of intestine can move into the inguinal canal through the weak spot in the belly wall. This causes an inguinal hernia. Most inguinal hernias happen in boys.

As an unborn baby develops during pregnancy, there is a small opening in the abdominal muscles. After birth, this opening closes. But sometimes, these muscles don’t fully close. A small opening is left. A loop of intestine can then move into the opening between the belly muscles. This causes an umbilical hernia.

Which children are at risk for a hernia?

Hernias happen more often in children who have 1 or more of the following risk factors:

Being born early or premature

Having a parent or sibling who had a hernia as an infant

Having cystic fibrosis

Having developmental dysplasia of the hip, a condition that is present at birth

Being a boy with undescended testes,. This means the testicles didn’t move into the scrotum before birth.

Having problems with urinary or reproductive organs

Inguinal hernias

This type of hernia happens more often in children:

Who have a family history of inguinal hernias

Who have other urinary or reproductive problems

This type of hernia happens more often in the right groin area than in the left. But it can occur on either side.

Umbilical hernias

This type of hernia happens more often in:

African-American children

Babies who were born premature

What are the symptoms of a hernia in a child?

Hernias often happen in newborns. But you may not notice a hernia for a few weeks or months after birth.

Inguinal hernias appear as a bulge or swelling in the groin or scrotum.

Umbilical hernias appear as a bulge or swelling in the bellybutton area.

In both cases, the swelling may be easier to see when your baby cries, coughs, or strains to have a bowel movement. It may get smaller or go away when your baby relaxes. If your child's healthcare provider pushes gently on this lump when the child is calm and lying down, it will often get smaller. Or it may go back into the belly.

In some cases, the hernia can’t be pushed back into the belly. Then the loop of intestine may be stuck in the weak spot of abdominal muscle. When this happens, symptoms may include:

A full, round belly

Belly pain and soreness

Vomiting

Fussiness

Redness or discoloration near the hernia

Fever

If the stuck intestine is not treated, blood supply may be blocked to part of the intestine. This is a medical emergency.

Hernia symptoms may seem like other health problems. Always talk with your child's healthcare provider for a diagnosis.

How is a hernia diagnosed in a child?

Your child’s healthcare provider can diagnose a hernia by doing a physical exam. The healthcare provider will see if the hernia can be gently pushed back into the belly. This is called a reducible hernia. The provider may order abdominal X-rays or an ultrasound to check the intestine more closely. This will likely be done if the hernia can’t be pushed back into the belly.

How is a hernia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Inguinal hernia

Surgery is needed to treat an inguinal hernia. In many cases, surgery is done soon after the hernia is found. That’s because the intestine can become stuck in the inguinal canal. When this happens, the blood supply to the intestine can be cut off and the intestine can be damaged.

During hernia surgery, your child will be given anesthesia. A small cut or incision is made in the area of the hernia. The loop of intestine is put back into the abdomen. The muscles are then stitched together. Sometimes, a piece of mesh material is used. This helps strengthen the area where the muscles are repaired.

Children who have surgery for an inguinal hernia can often go home the same day.

Umbilical hernia

In many cases, an umbilical hernia closes on its own by the time a child is 1 year old. Almost all umbilical hernias close without surgery by the time a child is 5 years old. Because of this, there are different opinions about when surgery is needed for an umbilical hernia.

In most cases, your child's healthcare provider may suggest surgery if the umbilical hernia:

Gets bigger with age

Can’t be pushed back into the abdomen

Is still there after age 3

Always contact your child's healthcare provider to see what is best for your child.

During surgery for an umbilical hernia, your child will be given anesthesia. A small cut or incision is made in the belly button. The loop of intestine is put back into the abdomen. The muscles are then stitched together. Sometimes a piece of mesh material is used. This helps strengthen the area where the muscles are repaired.

Children who have surgery for an umbilical hernia may be able to go home the same day.

What are the possible complications of a hernia in a child?

Sometimes the loop of intestine that pushes through a hernia may get stuck. Then it is no longer reducible. This means that the intestinal loop can’t be gently pushed back into the stomach. If not treated, blood supply may be blocked to part of the intestine. This is a medical emergency.